Background. The wide use of ionising radiation in medical care has resulted in the largest man-made cause of radiation exposure. In recent years, diagnostic departments in Kenya have adapted the high-speed film/screen combination without well-established quality control, objective image quality criteria, and assessment of patient dose. The safety of patients in terms of justification and the as-low-as-reasonably-achievable (ALARA) principle is inadequate without quality assurance measures.
Aim. This study assessed the level of film rejects, device performance, image quality and patient dose in 4 representative hospitals using high-speed film/screen combination.
Results. The X-ray equipment quality control tests performance range was 67% to 90%, and 63% of the radiographs were of good diagnostic value. The measured prevalent chest examination entrance surface dose (ESD) showed levels above the international diagnostic reference levels (DRLs), while lumbar spine and pelvis examination was the largest source of radiation exposure to patients.
Conclusion. The optimisation of patient protection can be achieved with optimally performing X-ray equipment, the application of good radiographic technique, and continuous assessment of radiographic image quality.

Patient dose, Image quality, Quality Control and Radiographic examinations.